Clinical Cardiology

Introduction | Objectives | Faculty and Staff | Prerequisites and Applications | Employment and Benefits | Orientation | Advisors and Mentoring | Clinical Service Responsibilities | Teaching Responsibilities | Educational Opportunities | Graduate Program | Research and Scholarly Activity | Evaluations | Specialty College Requirements | Board Certification | Expectations |

Introduction

The Residency in Cardiology at the Ohio State University College of Veterinary Medicine has offered advanced education and clinical residency training since 1975. The program is ACVIM-approved and supervised by faculty members of the Cardiology & Interventional Medicine Service. The residency is three years in duration and integrated with the Graduate-Residency Program of the Department of Veterinary Clinical Sciences. The program provides the trainee with focused clinical training in the specialty of veterinary cardiology and a clinically‑oriented graduate education leading to the Masters degree in Veterinary Clinical Sciences. The training program is designed to prepare the resident for a career in either clinical academic medicine or in specialty cardiology practice. The faculty mentors do recognize that most applicants are still considering career options at the time of their application. For those candidates focused on an academic research career, there is also a potential for advanced research training (PhD or Fellowship) in the College of Veterinary Medicine’s Graduate Programs immediately following completion of the residency.

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Objectives

The main programmatic outcomes of the residency include successful completion of the ACVIM certifying examination in Cardiology and completion of departmental requirements in graduate education. These goals are met by combining an outstanding trainee with a well-structured program that spans three years. Specific objectives are focused on the resident developing:

  1. An understanding of the basis and mechanisms underlying cardiovascular (CV) diseases
  2. Expertise in the diagnosis and management of CV diseases affecting domesticated animals
  3. Competency in performing and interpreting noninvasive and invasive diagnostic studies of the heart and circulation
  4. Competency in performing catheter-based interventional CV procedures including catheterization and pacing
  5. Experience in managing small animal patients with non-cardiac thoracic diseases
  6. Development of clinical and didactic teaching skills
  7. Development of basic clinical research skills with contribution to the veterinary literature
  8. Attainment of the MS in Veterinary Clinical Science at the completion of the residency  

 

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Faculty and Staff

The Cardiology & Interventional Medicine Service includes four faculty members, two residents (currently a first and third year), and two technicians. Faculty members directly involved in support of the program include four board-certified cardiologists.  Drs. John Bonagura (Program Director), Karsten Schober, and Brian Scansen supervise clinical training and Dr. Robert Hamlin supports cardiovascular education and research efforts. There are other ACVIM faculty specialists on site with practices in internal medicine, neurology, and oncology. Other departmental faculty working in the Veterinary Medical Center include Diplomates in the specialties of Radiology/ultrasound/nuclear medicine, Anesthesiology, Emergency and Critical Care Medicine, Ophthalmology, General and Orthopedic Surgery, Dermatology, Behavior, Microbiology, and Theriogenology.  ACVP anatomical and clinical pathologists actively support the hospital program. The resident and cardiology faculty members on service work side-by-side as part of a service (with students and sometimes with interns). At least one faculty member is always assigned to active clinical duty and to emergency backup.

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Prerequisites and Applications

Applicants must be graduates of a faculty-approved College or School of Veterinary Medicine with demonstrated academic proficiency (academic standing in the top 50% of the class or better is expected). They must have completed a one-year rotating internship or equivalent experience (that is acceptable to the cardiology faculty). All residents must be eligible to obtain a limited (university) license to practice veterinary medicine in the State of Ohio. At least three references are required.

Admissions requirements to The Ohio State University Graduate School must be met without conditions. A cumulative GPA of 3.0 is required for professional (Veterinary degree) coursework. A cumulative GPA of 3.0 is required for all undergraduate coursework.  A cumulative GPA of 3.3 is required for previous graduate (Masters or Doctoral) coursework. GRE scores are required with a verbal score higher than the 25th percentile and a quantitative score at or greater than the 50th percentile. GRE may be waived for international veterinarians.  Original transcripts for ALL college coursework will be required.

Beyond these minimal requirements, the Cardiology Faculty members consider additional factors before ranking applicants for our residency program. These specific performance characteristics include:

  1. Academic record and potential for self-learning
  2. Clinical proficiency demonstrated during a high-quality internship
  3. Clinical skills and common sense
  4. Ability to communicate effectively and work cooperatively with others
  5. Professional and personal ethics and comportment
  6. Desire to train within an academic veterinary center while actively participating in clinical teaching and clinical research, and
  7. Personal or professional experiences that help to distinguish the applicant.

Cardiology residencies are very limited and highly competitive. Ohio State currently takes two residents every three years in a staggered schedule. The next available position starts in July 2014 following the 2013-2014 American Association of Veterinary Clinician’s VIRMP method (http://www.virmp.org/). The overall application process for Cardiology can be summarized as follows:

  1. Application by potential trainees through the VIRMP “Match” system. While the 2014 deadline is December 9, 2013, interested applicants should endeavor to submit their information as early as possible (October 15, 2013 is the first available date set by VIRMP) because we need to review and invite applicants for interviews.
  2. Review of applications by the faculty (including contacting of references – we generally contact references directly if a letter is not yet on file) – we start reviewing applications October 15, 2013.
  3. Invitation of candidates for interview – As we review available applications we will invite candidates to our program. We will continue to review applications up to the December 3rd deadline for VIRMP submission but will have previously set our interview dates.
  4. Ranking by candidates and institutions following VIRMP policies and procedures. Please note that the VIRMP has set a relatively condensed time frame this year with January 17th and January 24th set as deadlines for candidate and institutional rankings, respectively.

As suggested above, we follow a specific procedure for interviewing prospective residents. We only invite those candidates who we believe have a realistic chance of matching with our program. We typically invite about 10 applicants to spend a Saturday with us for detailed group discussions, facility tours, and personal interviews. During this time, every applicant will spend at least 30 minutes, one-on-one, with each faculty member, each current resident, and our staff members. We have found that interns can more readily schedule a weekend interview date and that we can devote all of our attention to our visitors when these are conducted on a Saturday. The date for the 2013-14 interviews is Saturday, January 4, 2014.

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Employment and Benefits

The following summarizes employments and benefits of this position:

  1. Salary: $31,440 during year 1; $32,058 year 2; $32,688 year
  2. Health insurance: Insurance is provided as part of the student health plan at The Ohio State University as all residents are dually enrolled in the Graduate School.
  3. Travel allowance: Residents are provided $1,000 by the department for travel over the course of the program. The Cardiology faculty will provide additional support for textbooks for journal/book club as well as substantial financial support for residents to attend the ACVIM Forum (during the second and third years) as well as one additional medical cardiology meeting.
  4. Leave/Vacation: Residents receive 10 personal/professional days of leave each year.
  5. External cardiology rotations: These can be arranged in consultation with the faculty. It should be noted that outside consultation and outside employment during the residency are strictly prohibited.
  6. Licensure: Limited Ohio license to practice veterinary medicine is required; these fees are paid by the department.

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Orientation

During the first week of the residency program, all incoming residents participate in a comprehensive orientation program to introduce them to the department, college and university, complete necessary documentation, and to facilitate integration into our program and activities.  

Once the resident starts on the cardiology clinical service there is constant faculty supervision of clinical activities rotated among the three clinical cardiologists. There is also a faculty backup schedule for off-hours and holiday emergencies/procedures. As might be expected, residents are gradually introduced to the medical, diagnostic, and interventional practices of the service at a rate appropriate with their experience and training. In terms of interventional procedures, residents initially observe, then participate, and serve as primary operators during the first year of their training. A faculty member is actively involved with every catheterization procedure (as the primary or as a secondary operator). In many cases, both residents will be actively involved in the procedure. During the first year, the resident will spend 2 to 4 weeks rotating on the Internal Medicine Service. One week is spent during the residency with the Diagnostic Imaging Service (with emphasis on cardiothoracic imaging).

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Advisors and Mentoring

The resident will be assigned a primary ACVIM clinical advisor at the onset of the program and a primary research advisor (later, during the first year). The clinical research (MS) project is further supported by a Masters committee of faculty members. Residents are provided with very strong faculty support for the success of their clinical training, their board preparation, and their clinical research project. All past OSU cardiology residents have successfully passed the ACVIM Certifying examination within the required 3-year period.

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Clinical Service Responsibilities

Clinical responsibilities are scheduled throughout the 3-year (36 month) residency. The resident spends 30 months in scheduled clinics within the Veterinary Medical Center. The annual cardiology caseload is approximately 1500 – 1600 cases yearly. Emergency service is shared with other cardiology residents. Six months (approximately 2 months each year) are designated as off-(primary) service to allow for clinical research, board- preparation, and vacation.

The service receives patients and emergency transfer patients Monday through Friday. The daily workload is focused on referral cardiology, in-hospital consultation in small and large animals, and management of small animal patients with respiratory diseases. The service also carries an interventional medicine component (the official service name is “Cardiology & Interventional Medicine”). This includes cardiac pacing, cardiac and vascular catheterizations and interventions, and catheter-based treatments for airway and urinary tract disorders. The focus for the Cardiology residency is on cardiac and vascular diseases, but the resident also will be exposed to other interventional procedures. These are conducted in a new catheterization facility under the service’s auspices and supported by two cardiology technicians. Interventional procedures are usually scheduled for days when two faculty members are on service so that one can focus on catheterizations and the other on the medical cardiology service. Emergent procedures are performed as required.

The Cardiology Clinic caseload is approximately 90% cardiovascular disease-based and about 10% respiratory disease-based. Large animal consultation is a small but regular part of the caseload. Daily interaction with colleagues in other specialty services (see Faculty, above) is typical as we provide and receive case consultation for our patients.    

As indicated above, residents have limited emergency-care responsibilities; currently this involves backing up emergency interns for cardiology patients. Intern backup responsibilities occur during both “on-clinics” and “off-clinic” periods, though the faculty or other residents assume back-up calls during designated board preparation time, when the resident is on vacation, or as required to assist the resident with procedures or patient management.

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Teaching Responsibilities

The service has a reputation for high-quality teaching including those residents who participate in our program. We expect our residents to be interested and engaged teachers of senior veterinary students and interns. Most teaching is done in the context of the daily clinical workload with one-on-one case teaching and participation in daily rounds, typical of most academic centers. Residents deliver a small number of class periods and laboratories in the preclinical curriculum.

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Educational Opportunities

The residency combines clinical training and rounds, weekly seminars and classes, self-study, and clinically-relevant research. The program is highly structured and organized to facilitate both clinical training and focused post-graduate education.  Specific goals are the development of strong competencies in physical, imaging, and laboratory diagnosis, echocardiography, electrodiagnostics (ECG, Ambulatory ECG), cardiac catheterization, cardiac pacing, interventional cardiac procedures (such as PDA closure and balloon valvuloplasty), along with clinical competency in respiratory endoscopy.  Cardiology residents also are expected to develop at least core competency in general internal medicine and advanced skills in small animal respiratory disease diagnosis and management. The hospital is well equipped with two GE Echocardiographic systems (included TEE) as well as a new fully-equipped catheterization/interventional medicine suite. There is a dedicated area for Cardiology that includes an adjacent clinical Echo lab.

Clinical training is augmented with a series of seminars, journal clubs, book clubs, and classes that constitute the didactic portion of the training program. Residents receive a formal education in mechanisms of disease, pathophysiology, pharmacology, and clinical sciences. All hospital residents at Ohio State participate in the MS degree program (described in more detail below) and these classroom experiences are designed to prepare the resident for general and specialty board examinations as well as fostering the highest quality practice in the academic or private sector.  There are other opportunities for training and education at the OSU Medical Center and the Nationwide (Columbus) Children’s Hospital. Residents have access to extensive cardiovascular video, slide, and pathology libraries. Residents attend two ACVIM Forums (2nd and 3rd years) and may attend at least one human cardiology conference during their residency.

Conferences and seminars include weekly journal club (3-4/month) or cardiopathology rounds (once/month); weekly medical Clinicopathologic conference (case presentations by all ACVIM residents and faculty); and either scheduled resident-graduate classes or additional cardiology seminars (topics, book club, ECG reading, etc.). These are conducted every morning from 8-9 AM (sometimes from 7-9 AM on Wed/Thurs). Residents are expected to be involved in these educational activities and these are almost exclusively taught by the departmental faculty. All seminars and classes are conducted in the Veterinary Medical Center.

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Graduate Program

Resident education is enhanced by completion of a graduate curriculum of courses in advanced veterinary internal medicine. Currently, cardiology residents can complete all of their needed coursework within the Veterinary College Campus in the 8-9 (or 7-9) AM resident educational block periods. Classes are taught prior to routine clinical duties. Classes in Veterinary Clinical Sciences are focused on clinical subjects. There are specific courses in advanced cardiology (cardiovascular physiology, electrocardiography, pharmacology, and cardiovascular medicine); respiratory medicine; nephrology/urology; neurology; gastroenterology; clinical oncology; clinical pharmacology; critical care medicine; and diagnostic imaging (including ultrasound). Not all courses are required but the resident must fulfill the requirements for the graduate school (typically enough courses have been taken by the beginning of the third year). Clinical conferences and seminars in the department are also available for graduate credit. The department also offers courses in research methods and data analyses that are especially relevant to residents who are conducting a clinical research project and learning to critically read the literature.

While a graduate program is not part of the residency program at most institutions, it has been a long-standing and well-integrated part of the OSU residency program for decades and sufficient time and faculty advising are available for completion of the research project. As previously noted, all of our past residents have successfully completed both the specialty board certification examination and the M.S. degree within the three-year period of training.

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Research and Scholarly Activity

Residents work alongside faculty mentors when conducting their research. The research interests of the faculty are varied, but are focused on spontaneous cardiovascular diseases of animals in the general areas of cardiomyopathy, echocardiography, cardiovascular pharmacology, and congenital heart disease. There is a Clinical Cardiology Research Laboratory (separate from the clinical space), that includes a second echocardiography system (identical to the clinical system). There is sufficient technical support to assist the trainee in clinical and laboratory studies. The faculty research mentor plays an active role in the planning, implementation, and analysis of the resident’s project and all cardiologists are members of the Masters committee. 

Graduate students are expected to complete their coursework and research in a diligent manner, and to conduct and complete their research on a scheduled basis. We expect the resident to submit at least one scientific manuscript for publication by the conclusion of the residency that is based on their clinical research. Our residents regularly present their research at ACVIM.

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Evaluations

The resident receives a structured performance evaluation from all faculty members twice each year (December and June). Progress is discussed and constructive criticism advanced with the intent of helping the resident reach her or his potential as a cardiologist.

The program is evaluated yearly as part of the ACVIM residency review process. We have been in constant compliance since 1975.

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Specialty College Requirements

Requirements for board certification are indicated in the General Information Guide (GIG) of the American College of Veterinary Internal Medicine (www. ACVIM.org) and should be consulted for details. Each resident has an individual program approved by ACVIM at the onset of the residency.

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Board Certification

The requirements for board certification are also indicated in the GIG. As previously noted, our residents are supported to attend ACVIM in the second year to write the general examination and in their third year to write the certifying examination. The passing rate for the residents trained at OSU is 100%.

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Expectations

Expectations for residents are best outlined during the orientation and initial months of training and then readjusted during semi-annual performance evaluations. General expectations are outlined under objectives. Residents can expect dedicated and interested faculty who are focused on patient care, clinical education and training, and programmatic (academic) goals of the department.